Introduction: Pituitary apoplexy is rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary adenoma. The prevalence is 2-12% of pituitary adenoma patients especially in nonfunctioning pituitary tumors however it can be developed in medically treated tumors.

Patients usually present with sudden onset of headache, vomiting, visual defect, and altered sensorium. Acut adrenal insufficiency may be result of adrenocorticotrophic hormone deficiency.

Aim: Pituitary apoplexy is a very rare but important disorder, and early recognition is necessary to start the adequate therapy. We are going to discuss the specific CT and MR signs in details of this case.

Methods: 51-year-old man presents with a 3-day history of worsening left sided visual defect. In his clinical status anisocoria, light-insensitive pupil, partial oculomotor nerve palsy and left-sided optic chiasma laesion were observed.

Result: Acut CT of head and sella MR examinations show a large intra-suprasellar and left parasellar haemorrhagic tumor, involving the left cavernous sinus, according to pituitary apoplexy.

Neurosurgeons didn’t indicate acut operation due to high risk of endocrin crisis. After a few days of conservative therapy at an endocrinological department, the operation was performed via paraseptal route. The pathological analysis confirmed a partially necrotic and hemorrhagic adenoma with follicle-stimulating hormone (FSH)-positive tumor cells.

The visual field defect and eye sight of the patient improved immediately and after 1 week the patient had no neurological abnormality. The patient had no complain after 3 months however we follow-up him routinely.

Conclusion: CT is often the first imaging tool in pituitary apoplexy, showing areas of hyperdensity within the sellar region. MRI could confirm haemorrhage within the pituitary gland and compression on the optic chiasm.

Instead of the formerly considered acut neurosurgical intervention, nowadays retrospective studies emphasize the wait-and-see management.

Funding: No funding was received for conducting this study.